Ah Yes, Medical School

Join me as I half-ass my way through medical school, encountering all sorts of freaks (patients, classmates, myself, etc.) along the way

Sunday, October 30, 2005

A Grand Entrance

It is perhaps the cruelest of ironies that while each and every person on Earth makes at least one grand entrance in their lifetime, an entrance so grand that they are truly the center of attention, they will without a doubt never be able to recall this moment for their entire lives. Now, the vast majority of us will never be able to follow through with subsequent grand entrances, achieved only by a select few and involving some of the following features: being able to walk down a red carpet, having everyone in a large room stop talking and begin looking at you, or the always classic walking into a crowded lecture hall 20 minutes late with the girl you just hooked up with quickly following behind you only to have 120 of your peers stop what they are doing, stare, and gasp in the sheer horror of finally understanding what diabolically evil sexual acts must have gone on among all those folds and male breasts the night before (this calls for the obligatory "Boop boop bee doop" inside joke understandable to about five people - apologies to the general public). However, there was that one time in your life when, after hours and hours of labor, you made your first entrance, your grand entrance, into this world covered in slime and providing that beautiful spectrum of emotions, ranging from “It’s a miracle!” to “How the hell am I going to pay for that?” for your parents. In honor of this moment, and as a nice way of capping off my two weeks on the labor and delivery service (which I thoroughly enjoyed - watch out ladies, I might actually want to do OB/Gyn), I thought I'd share a few of the more memorable delivery moments that marked a few special babies' grand entrances into this world, because, lets face it...it's all downhill from here:

Since the baby’s head was up, in a breech position that failed non-invasive attempts to correct this position, a scheduled cesarean section was indicated. The mother was wheeled to the operating room, and the surgery began soon thereafter. A few slices of the skin later, and the residents had reached the uterus, ready to expose the child and bring him out to the world he would be residing in for the next few years. Except the thing with a breech delivery is, no matter whether it’s a vaginal or c-section delivery, the butt naturally comes out first. So when the residents cut through the uterus and began extracting the baby from his mother’s womb, they had to reach inside and grab the baby’s behind, squeezing it through the hole they had just created. A hole, I should remind you, that was not all that large. Perhaps it was the pressure of the moment, perhaps the stress of the onlookers in their sterile garb, perhaps the fact that the surgeons were very strongly squeezing his butt cheeks, or perhaps it was the infant’s subconscious (or conscious?) knowledge that he was literally marking the beginning of his life with his best face forward, but he decided to greet the onlookers, surgeons, and parents the only way he saw fit given these circumstances: by dropping a massive poop all over himself, his mother, and a couple of unfortunately placed hands attached to an otherwise lovely and poo-free intern*. Well played, young man. Well played…

In the pre-delivery commotion that enveloped one labor and delivery room, just about everyone failed to notice the subtle but purposeful motion the husband made for their designer bag just as delivery was imminent and as he was trying (but failing) to give his wife breathing instructions through his counting. His wife, an attractive young woman pushing strongly while heavily medicated, started barking at her husband to stop counting and do away with all the stuff they’d practiced in a ritzy and posh Lamaze class they had attended in the months leading up to the surgery. Instead, just as the baby’s head was ready to emerge, the husband reached for his overpriced camera and started snapping pictures. Then, as the baby finally plowed her way through her mother’s vagina, he reached for his razor-thin cell phone and began calling someone, only to quickly shove the phone to his wife’s ear seconds after delivery, baby in hand and cord just severed. Sensing the ridiculous situation for what it was, the mother realized that she was not ready to talk on the cell phone…not now, not right after pushing a big baby through her not so big vagina, of course. How dare her husband ruin the moment by intruding with a cell phone. So naturally, given this situation, the mother did what any self-respecting woman would do. Throw the phone away and embrace her baby? Tell her husband he’s an idiot? Ask about any Jewish single men in the room? No, no, and…uhh…yes (see below). Instead, she began a habit she would likely regret sometime in the next ten to twelve years (and subsequently thereafter) and placed the cell phone on the baby’s ear, starting the baby on a habit more dangerous than crack, porn, and snacking on all the free food at Costco combined, all only moments out of the womb. Only twenty seconds into life, and this baby had taken to a cell phone and began making those odd baby noises into it, not wanting to relinquish its control. Sill mere seconds into life, and this baby had already used up valuable daytime minutes on her parent’s cell phone plan, already annoyed a whole bunch of people nearby by talking on a cell phone at an inappropriate time, and already gabbed enough on the phone to set in stone her destiny as a future Jewish American Princess. To whom was this baby speaking? Why did her parents choose to have her first conversation be on the phone? And why did the mother, while I was pulling a placenta out of her uterus and vagina, think it was an appropriate time to mention that she had a single younger sister she wanted me to meet? The answer to all these questions is unknown, but can likely be pieced together from within the cries of that fateful first cell phone conversation. Whispers of “Gucci”, “Louis Vuitton”, and “Prada” filled the steamy atmosphere, but not a single utterance of the word “Kirkland” was to be found (although they do make nice jeans and toilet paper.)…

The last delivery I was privileged to few was much like the first, and much like most of the ones in between. A family of five filled the room, a father, grandparents, and a couple of children, all anxiously waiting for that moment when mom would push yet another child into existence. Hours of labor passed by, with mom’s concentrated effort to push at two minute intervals not yielding much success in bringing the baby out but yielding many beads of sweat down her forehead. Eventually, however, the pushing began to work, because before we knew it, a head was plummeting down her vaginal canal and ready to burst into reality. The mom was now screaming in pain, the dad looking on anxiously, and the grandparents watching with a mixture of dread, despair, and hope while they covered their gaping mouths with their trembling hands. More pushing, and now the bulk of the head was visible. Pulsations were felt going across the baby’s scalp, and we knew she was almost ready to come out. A few more pushes and there she was, a blue baby girl, poking her head out of the womb she called home for about nine months and taking her first gasp of our atmosphere. As she was extracted from her mother’s womb, her father gave a cry of joy, her grandparents felt warm tears start streaming from their eyes, and her mother sighed in relief of a job well done, about ready to receive the fruits of her labor (pun marginally intended) when the resident quickly handed the baby over to her. The father then cut the cord, and the baby was now free, ready to begin life…

Why this last story, when it is clear that nothing eventful happened, nothing all that ridiculous, entertaining, or gross? Because what I’ve learned from my two weeks on Labor & Delivery is that even the utterly mundane, the uneventful, the sheer boredom inherent in obstetrics is more awe inspiring, more beautiful a moment in time than just about anything I have ever seen, whether in medical school or in life as a whole. There is really nothing quite like it, and even the simplest delivery to the most non-descript family at the most inauspicious time still warrants the title of a grand entrance for the baby in that family’s line, and I defy anyone to prove otherwise.

Can you believe what kind of a sap I’ve turned into these last few weeks? Good lord. Wait, what’s that? You can? Thanks.

Saturday, October 22, 2005

A Future

A few years ago, I wrote about the perks of being a medical student, as I was lavished with fancy dinners and hands that wandered where few women choose to go. As it turns out, last night I had the privilege to attend yet another of these grand dinner affairs, intended to wine, dine, and convince rich alumni and donors into giving more money by sitting them with ridiculously attractive medical students (and me) and having us entertain them with our tales of medical glory while they write checks. It then goes without saying that I am pretty sure this is the last time I will attend. Why, you ask so graciously as you pretend to listen? Not because I hoped the master of ceremonies, a nationally syndicated advice columnist, would revisit that part of my anatomy she had visited two years earlier and propel me into a stratosphere of unintentional comedy and awkwardness not seen since...well..since that awful blind date I went on a little while ago. In fact, after talking to me for only two minutes, this famous advice columnist apparently became so overwhelmed with my admission of built up Jewish guilt (she is also a Member Of The Tribe and at first acknowledged this guilt as normal) that, rather than...you know, give me advice (that being her job and all), she strongly encouraged me to go see a psychiatrist because I am apparently that insane. Ouch.

Instead, what really bothered me about this event was the casual conversation I was privy to at a random table filled with middle aged refined-appearing doctors and their plastic wives, dressed up to scream both "I have class" and "I am more expensive than you" but proving the always dependable Trophy Axiom, which boldly states that these ladies may have been trophy wives once, but just like all those bullshit trophies you got in AYSO soccer when you were a kid, they all end up in the trash sooner or later. After progressing beyond the casual "So where are you from?", "What kind of doctor do you want to be?", and "Let me tell you about my amazing children...", the subject inevitebly turned to the specific source of funding I had received that garnered my invitation to this event. Rather than admit that I was just there to keep my friend company and maybe, just maybe, score with a quasi-celebrity, I brought up the huge wad of cash these people indirectly sent my way so that I could participate in an incredible program last year that allowed me to travel to a small town in Mexico and live and work in a hospital for a month . Here is the dialogue that ensued:

Me:...so it was an incredible experience, I learned a lot, and the people there were so generous.Lady 1: So how is your Spanish now?Me: Oh it definitely got a lot better.Lady 2: That's great...you know, I tried to pick up some Spanish too...Lady 1: How come?Lady 2: Well, you se-Lady 1: Wait, let me guess - your housekeepers weren't doing what you wanted but you couldn't tell them how you wanted your house cleaned, right?[Both ladies laugh hysterically. Doctor-husbands nod in approval and laugh as well.]Lady 2: How'd you know?!?Lady 1: I tried the same thing, but I was too lazy to learn Spanish, so I just scream at her when she does something wrong. Help these days...it just isn't the same like it used to be.Doctor 1: Say, maybe you could teach us some words, like "clean" and "windows"![More middle-aged laughter]

Apparently, these people did not get that memo passed around to Whitey a few years ago that this sort of dialogue and behavior was just not OK anymore. The conversation then twisted and turned to the demise of a local public school system as a result of the alarming influx of immigrants over the last twenty years. By this point I decided I'd had enough, got up, and left.

As a future doctor (well, let's see if I passed that surgery final first), I very well may find myself at some point being offered admission to these kinds of social circles (unless they read this crap, of course), since for whatever reason physicians have some easier access to these echelons of society simply by virtue of the MD at the end of our names. So I chose a careful title this time around, because I want to emphasize that what I described was a future, but not necessarily mine or those of my peer medical students. While I use this forum mostly as a method of catharsis, venting, and a chance to dish out my cynicism (there will undoubtedly be plenty of my peers who choose that path), I also use it as an opportunity to discuss my utter cluelessness about what I want to do with my life. However, last night was the first time where I felt confident about my future, only in so much as I know about a future I do not want and will not pursue, which I guess counts for something. The allure and illusion of the trophy is nice, but I'll take the genuine guilt that has gotten me this far anytime.

Sunday, October 16, 2005

Ask The Fake Doctor 3

In my third installment (Can you believe I actually made it to three of these? Me neither.) of Ask The Fake Doctor, I will do my best to answer your questions and concerns, as well as respond to any appropriate comments. But first, a few general comments I feel like I should throw out there:

1) I'd like to formally thank the kind folks at www.blogger.com for bestowing upon my blog the honor of "Blog of Note", which has given me a much wider audience and allowed me to more thoroughly gross out, disturb, and at least mildly entertain a whole host of people I don't know. Although I’m sure right now the blogger people are all sitting around their board room, shaking their heads in disgust at noting a blog that went on a vagina rant for the next three or four posts straight. Sorry everyone.2) I have been inundated (well, at least for me) with emails and comments since this newfound notoriety began a week or two ago, including various questions, requests for links, and so on. I have tried to respond to everything I can in this and future Ask The Fake Doctors or with direct emails when appropriate, but it has been hard to find enough free time to do all this and, well, you know...save lives as the dashing third year medical student that I am. Also, I tried to add a bunch of links to my site to reflect the broader medical and blog community indicated by your various comments, but when I tried to do that I almost deleted my entire site by accident and decided to end that experiment then and there. I promise I'll try again if/when I grow larger testicles, but I appreciate the links to this site that have popped up nonetheless.3) Mixed in with the various questions I would be able to answer (you know, about balls, vaginas, etc.) have been a few questions sent my way that involve actual (potentially serious) medical concerns. Christ guys, go to a doctor if you have a real medical question! I can't even tie my shoelaces half the time, so I'm really not qualified to give real medical advice. OK, just had to get that in print for future ass-covering medico-legal concerns. I can’t believe I just wrote “medico-legal”. It’s official, I just sold out. That didn’t take long at all.4) I really appreciate all the feedback I have received, both positive and negative. Regarding any concerns that I simply delete comments that are not favorable, I would like to assure you all that a) the only comments I have ever intentionally deleted were obviously spam, b) I welcome negative feedback, because I am learning a lot about how my humor is (or, as is most often the case with negative feedback, is not) being interpreted by different people, and, most importantly, c) as those who know me personally can attest to, I am, in all aspects of my life, harder on myself and more self-deprecating than anyone I have ever met, and any negative feedback is probably a sampling of something I've already pointed out to myself in the past...so, in other words, feel free to tell me I'm an insensitive prick with an ego bigger than Ron Jeremy's penis who wouldn't know a vagina if it slapped me in the face (that last part, of course, may or may not actually be true).5) Regarding the gross-out nature of the most recent post...don't say I didn't warn you! No seriously, don’t say it. Sometimes I forget that most people don't spend there days knee deep in human feces and bowel, and they are often phased by things that I have come to embrace…like feces and bowel. And since I got a bunch of questions about this, let me just clear things up by saying that sorry, it was amniotic fluid and not urine (although technically…ah screw it), the vaginal tear that woman experienced was very rare, it is (and was in that case) surgically correctable, her and her baby are doing fine, the residents did everything correctly and exactly in line with what they were supposed to do (the tear occurred when the baby burst it's big head through the woman's pelvic canal, which brings up the question of why was the baby so big in the first place? Feel free to read up on gestational diabetes and decide who, if anyone, is really at "fault".), and, as was pointed out by a commenter, that tear does not always lead to bowel incontinence. So please, ladies, keep getting pregnant, because what I described was a total freak occurrence and not the norm (which, having seen a few normal deliveries myself, is simply ghetto fabulous). Maybe you would want my help with this whole getting pregnant thing? Just thought I'd offer.

Now that all of that's out of the way, let's see what you all are made of:

a preamble: I am profoundly depressed and I have no idea what the hell I am doing in this life. content: I stumbled upon your blog randomly. So randomly, in fact, that it can not possibly be random. Dig?...so, should I try school again and become a doctor?-M.K.

Unfortunately I am not a Jewish female or a female at all, however I do have a question since I am aspiring to go to med school in the far future. What advice can you give me to ward me off of this complex decision while I still have a fleeting chance?-Stan

Ignoring the broader question of fate versus free will and randomness indicated by that first email, if only because I’m not stoned and therefore not adequately prepared to discuss such matters, I will instead humbly suggest that you read through this and perhaps less cynical accounts of medical school and decide for yourself. If you are specifically interested in the application process as a microcosm for whether you should really be putting yourself through all this, as that process really feeds (or it should, in theory) on people with a genuine desire to pursue medicine, read my first Ask The Fake Doctor post, since that might help.

Dear Fake Doctor, what do you recommend for a patient who is losing his mind? -J.D.

Go out, meet some girls (or guys…or both!), and get some action. Do I have a serious answer to this question? No, because I have been losing my mind for the last 2.5 years now. Actually, here’s an idea: start a blog and begin ranting about what troubles you, and someday you’ll start to feel better. At least that’s the faint slice of hope I am currently clinging to.

Have you noticed that, during the past several years of blogging, your writing, grammar, punctuation, use of initial caps, and awareness of "its" vs "it's" for "it is" has improved? Do you credit med school, the amount of time writing/blogging as increasing your awareness of how to articulate thoughts, or something else? Sad to see this talent disappear once you begin to write prescriptions.-J.T.

I think it’s more that when I first started this, my mom kept telling me a) she couldn’t understand what I was writing, b) that I needed to write in something that vaguely resembled complete sentences, and c) that I needed to stop cursing so much. If you think I’m joking then you don’t have any friends with Jewish parents. My mom still tells me I curse too much. In all seriousness, I have only noticed this trend you mentioned after I went back recently to look at some of the older posts newfound readers started commenting on. I’m not sure I have any explanation for it, other than that the neurotic Jew in me wouldn’t be able to rest knowing that there were hordes of errors in stuff I had written that was being read by other people, whereas early on I was writing for an audience of three (me, my mom, and Natalie Portman).

I'm not Jewish, but I have a question: Why (and I'll restate that in big letters just to get across my confusion), oh WHY do all doctors think that drugs should be the first solution to everything? Well, except German doctors who can prescribe herbal rememdies. Why do they think it's acceptable to give you a pointless prescription full of some crappy artificial substance that will screw around with your body probably doing as much harm as good?-Claire

I have two responses this very valid question:1) Much of the satisfaction gained from practicing medicine is in actively witnessing a positive change in a patient, and even more so knowing that you were the person at least partially responsible for that change (“I filled out the form that let the senior resident perform the surgery that saved that man’s life today mom!”). However, many medical problems these days center around chronic disease management for which there is no clear cure, so in an effort to feel like we are still helping you, we prescribe pills that often can help and hopefully at the minimum do no harm to you while possibly controlling your chronic disease. Of course, we do realize that there are side effects with medicines (as with herbal remedies, it should be noted), but there are risks inherent in any proposed method of cure. So, in summary, we dish meds out because, if nothing else, it makes us feel like we are doing something for patients even if it is not really helping all that much, because if we didn’t have that option there would really be no hope and we’d all just get depressed and quit. That, and don’t we just look so cool writing out those prescriptions?

2) Perhaps the bigger reason why we dole out all those meds is not for any fault of our own, but it’s actually all of you, the patients, that force us down this path – we dish out the drugs because the patients demand them. Oh he did not just go there! But I did, and please hear me out before clicking submit on that nasty comment (of course, feel free afterwards). Let’s take as an example what I like to call The Big Three that envelope the vast majority of medicine these days: Diabetes Mellitus Type 2, Hypertension, and Heart Disease. Yes, there are plenty of medications we give out to control these health problems, and yes, they have risks of messing with your liver, kidneys, heart, and so on. But here’s the catch: if instead of writing out a prescription for some drugs we only told you to get off your ass, exercise, and eat right, you (the royal “you”) will more often than not do some combination of a) try that plan for 2 weeks and quit, b) ignore us completely and show up three years later about to die, and c) get mad at us for not giving you some medications, where you just have to pop a few pills a day to control your blood pressure, cholesterol, etc., so that you walk out the door and complain to your friends that your doctor didn't do anything for you (of course, then there’s all of you who are given the drugs, have the means to pay for them, and still don’t take your meds, showing up at an ER years later clutching your heart in agony and demanding to know how you got to this point). Can you imagine what kind of patient revolt would occur if doctors actually stuck by the “Try diet and exercise for a year and get back to me if that doesn’t help” route, even though diet and exercise are the only things that will always work at no increased risk to the patient? I’ve seen patients literally sit there and insist on the latest drugs right after their primary care doctor I worked with spent a whole session trying to counsel them on the importance of diet and exercise. Do you see where I’m going with this? Doctor’s have an immense responsibility to provide you with healthcare and do so with the tools we’ve been given, whether they be diet management or pills, but you have just as large of a responsibility for looking after your own health as well, which isn’t always equivalent to demanding the latest and greatest new drug. I have no idea if what I just wrote made any sense whatsoever.

Now if you will excuse me, I will carefully lower myself from off the high horse that I am currently sitting on (I call him Chubbs), and proceed. There, all done.

P.S. I love it how so many of you have qualified the beginning of your comments/emails with an “I’m not Jewish” statement – don’t worry, I forgive you.

During the course of your Medical training you learn to detach yourself from your patients yes? If that's so....how do you then switch that off when you leave the Hospital? I've often wondered about Gynecologists... do they go home to their wives and girlfriends and think ewww...?-W.M.

You bring up a very interesting point regarding detachment from patients. Much of our time in the first two years of medical school is spent in classes that strongly urge and pressure us to be sensitive, take our time with patients, and truly get involved in their lives. After all, these ideals represent what just about everyone would want in a doctor, and they seem reasonable enough. Except then one day, during your general surgery rotation at a county hospital, you find yourself dropped into a service with only three residents, and this team is expected to round on 37 patients in one hour. Doing the math, that amounts to 1.62 minutes per patient. What point am I trying to make here? I firmly believe that all doctors-to-be go into medical school with a big heart and that “I want to help people” mentality, but then reality shoves her acne-riddled, bloated face in their way and they slowly shift from spending as much time as they can knowing their patients to making sure they have acquired the maximum amount of information in the smallest amount of time that will appease their superiors. Why? Because there are 60 patients in the waiting room demanding to be seen right now, and one of them may or may not be packing a rifle. Of course, every patient thinks he or she is the most important patient there, and who is anyone to say they are wrong…I guess what I’m trying to say is, I have yet to see a doctor not busting his or her ass day in and day out, but given the medical establishment as it currently stands, it is really difficult to make it through the day without detaching yourself from the patients and still having enough left over to come home and be at least moderately functional. Regarding gynecologists specifically, I am not entirely sure, but I do recall an episode of Friends that dealt with that issue head on (and no, I wasn’t the guy playing the ambiguously gay, sarcastic character on the show, damn it.)

Demonstrated by my previous post (and now and then in the past as well), as one progresses through medical training, ones threshold for what really makes the eyes jump out, the mouth gape open, and the insides curl up in a fit of terror keeps getting higher and higher. And yet, just when you think you’ve seen, touched, or smelled the most awful thing you will ever see, touch, or smell, some new poor bastard waddles his or her way into the ER to prove you wrong. When this happens, and it keeps happening to me on a weekly basis, we find ourselves searching for the phrase that best encapsulates this newfound appreciation for the freakiness inherent in human beings…and it just so happens that “I shit you not” best encompasses these feelings. I mean, it’s not just that it happened, I am not even shitting you that it happened! That made no sense. If you have any better suggestions, feel free to submit them for general usage (perhaps “I pee you not!”, “I shit you sometimes!”, or perhaps a more simply stated “Inconceivable!” to commemorate the late, great Andre The Giant is in order. (I can’t believe I just worked in an Andre The Giant reference. Somewhere, up in freakshow heaven, he’s surely smiling and eating a peanut. If you get that last obscure movie line reference, you are my hero.)

Why do you have to advertise to find a girlfriend?...I'm just curious as to where it says in your religion that pork isn't to be eaten. Are pigs (of ALL animals), supposed to be holy or something?-J., Edmonton, Alberta, Canada

I advertise partially as a joke, partially because my friends insist on it as no other forms of meeting girls has worked, partially because I don’t have much free time to go out and meet girls anyways (and lets face it, even if I had time, I’m pretty bad at this), and partially because yes, ladies and gentlemen, I am that pathetic. Oh, and partially because one day Natalie Portman is going to come across this site and, well, you know…Regarding your second question, I regret that my six years of Jewish elementary day school education only left me with a working knowledge of how to say “I need to go to the bathroom” in Hebrew, along with some other bits of wacky Jewish knowledge (like did you know that Ron Jeremy is Jewish, thereby contradicting the generally accepted notion that Jewish men have small penises but compensate by being voraciously good at love-making? That’s two Ron Jeremy references in one post, just in case you’re counting.), so I found this link that might help enlighten you on the intricacies of what it means to be kosher (which, in case you are curious, I am as well). And speaking of food…

What type of meal does one feel like tucking into after scraping cells out of a vag? -Lithanee

Personally, I’ve always preferred a simple bean and cheese burrito from Baja Fresh - black beans, extra crispy, with excessive pico de gallo placed inside and a mound of pico de gallo and the green sauce poured on top. I’m drooling just thinking about it. So either that…or…I don’t know…maybe a…fish taco! Sorry, the previous sentence had to happen or else I wouldn’t be able to sleep at night.

You're starting to resemble George on Grey's Anatomy. Are you sure you're not pulling a "single white female" thing on these hapless unsuspecting female residents? If not, let me say that I am duly impressed by any man that can, not only get in touch with his feminine side, but go public with it. Hoorah for you. Can you tell me...how many dates do you get with such newfound estrogen flowing through your veins?-beertapgirl

Are shows like Greys Anatomy realistic?-Alex R2000

After being pointed to a well-written rant on the serious reasons why Grey’s Anatomy is subpar, I felt it was time for me to contribute to this general ranting by providing my less than serious take on this show, which I admit to watching as I type this but also cannot stand. Here’s a few reasons why:1) In one episode, the show opens up with our hero, Dr. Grey, jogging with her co-resident in broad daylight, all prior to showing up at the hospital. Maybe Seattle has its own special climate and light control system that the rest of the world is not privy too, because that is the only explanation I can come up with for how any surgical resident on the face of the Earth has time to get in a run in broad daylight before work. There is simply no way in hell this happens. Ever. If she’s not pre-rounding on her patients by 5 AM, then she’s going to get her ass kicked out of that program faster than you can say Doogie Howser. As someone who had to experience this morning routine for six weeks, only a fraction of what a true surgical resident has to endure, I was still fuming at the sight of this televised blasphemy, if only because my non-medschool friends start giving me crap about why I don’t have any free time because “the doctors on Grey’s Anatomy seem to have all the time in the world!”. Pricks.2) I can almost guarantee that any medical student, intern, resident, or attending in America has been posed with a statement like this one: “Set me up with one of you co-workers…I mean all the doctors on Grey’s Anatomy are so hot!” Let’s think about this for a moment. On average, who becomes a doctor? Smart people who did well in good colleges. On average, who were these smart people who got into these good colleges? Smart people who did well in high school. On average, who were these smart people in high school? The ugly people who didn’t get laid! So post-puberty miracles aside, we are, on average, not even close to being as hot as the doctors on that show are. At least ‘er’ had a balding pasty white guy on the show for a while. I mean, c’mon.3) The show is littered with medical inaccuracies that even the dumbest third year medical student can pick up (that’s my cue). It’s all over the place, from OR etiquette to patient management, so many things are depicted on the show would never occur in real life. Of course, that’s why it’s a fake TV show, and I really shouldn’t be judging this show in this way since I’m guilty of enjoying the first two seasons of The OC, knowing full well that OC reality isn’t nearly as hot as is displayed on TV. Still, at least you could stop having the attending surgeon wear that flower cap on his head…no real surgeon I’ve ever met would be caught dead in one of those things.4) George is the most unbelievable character on television. Why? Because there is no way a pussy like that would ever, EVER, get accepted to a real surgical residency program acting the way he does. You’d have to experience the surgical culture in its entirety to truly understand this concept, but it’s a wonder one of the chiefs on that show hasn’t ripped his head open yet. Of course, the fact that I am apparently starting to resemble him is really boosting that much-needed self-esteem.5) That's zero dates and counting!Wow, I feel so much better now.

This is why I no longer get pelvic exams--and I'm only 39…The crap we women have to put up with to stay healthy…Try to remember that the "hole" belongs to a woman, a person. Maybe you should have a rectal exam every year by some butt-ugly doctor with big hands making idiotic remarks without thinking. Think of your mother, maybe that will help. Good grief.-D.P.

I have two points to make regarding this comment:

I am currently learning how to be a doctor at a teaching hospital, which takes many forms (private, county, academic, etc.) and is where all medical students and residents learn. In this setting, we are here to practice the craft of medicine in a controlled and safe environment while attending physicians and trained residents, who all have years of experience, look over our shoulders and make sure we do things the right way and learn from our mistakes – you may have missed the part in the post you were referring to where my attending pointed out to me the utterly moronic sentence I had uttered, and I promise I’ll never say something like that again. I respect any person’s decision to choose to avoid teaching hospitals and avoid having to put up with morons like me fumbling on our words while taking a history or doing any part of the physical exam, as that is your right. However, I would not use my (and my predecessors) idiocy and knack for sticking my foot in my mouth at the most inopportune times as an excuse to stop getting pelvic exams or any other regular health checkup, as that is only putting you at risk for all sorts of otherwise wholly preventable diseases (like cervical cancer). I’m sorry that you’ve had to put up with what must have been plenty of awful experiences with the pelvic exam in the past, but I would encourage you to have your yearly exam for your own health. On the flip side, speaking for medical students everywhere, I really do appreciate patients who have no problem letting us learn with and from you, as that is really the only way this system of training future physicians will ever work. I think I just found myself on my high horse again. Really sorry about that, everyone.

Secondly, so let me get this straight: your suggestion for not making a fool out of myself in the future while doing the pelvic exam is, while I’m poking around in some woman’s vagina, to think of my mother? You’re kidding, right?

You gotta explain the clothes. White coats and green cotton pants have always been a mystery to me.-The Jamoker

I’m going to let you all in on a little secret: For some reason, unbeknownst to even the wisest sage or queerest eye (Yes, I’ve watched that show. Yes, I’m straight.), women love the scrubs-white coat combination. I have no idea why, but who am I to suggest that this color combination is more fitting for the cover of Green Eggs and Ham than for a medical outfit? If someone has a better explanation for this (and I’m sure someone does), please feel free to share.

Yup, I know exactly how you feel. I gained a perverse respect for anal anatomy, and enjoyed trying out my knowledge on my female roomate (nursing student). When I showed up with the anoscope, she was pretty game to try it. I remember every single time I scope someone in the clinic today. BTW I have a pic of her with the scope but I don't know how to load it onto your blog, just for your own education of course.-Durk

I love my new readers.

P.S. I actually got a set of nude photos! Unbelievable. Seriously, I love all of you.P.P.S. I am about to start my actual OB and Gyn in-service parts of the OB/Gyn rotation (versus the outpatient clinic weeks), and my free time is about to diminish rapidly. I’ll try my best to share the latest gross and/or personally embarrassing stories that I have been involved with as regularly as possible, but I admit that this will become more difficult in the short-term and I apologize in advance.P.P.P.S. Longest. Post. Ever.P.P.P.P.S. Have you ever seen a P.P.P.P.S. before?!? Kind of like that whole *** thing. I have no idea why I find this crap so fascinating.P.P.P.P.P.S. Are you still reading this? Unbelievable.

Friday, October 14, 2005

A Tip Of The Cap

Proving that this site is not just here for me to vent about all that is difficult, frustrating, and utterly vomit-inducing about medical school, but also about educating the public on various medically related topics, I would like to submit the following entry inspired by my two call nights on the labor and delivery team. Since I got into a bit of trouble with my last post and kept hearing about people hacking up their Cheerio-O's after clicking on some of the (cough) purely educational links I spent countless...umm...minutes scouring the internet for, I should warn you that what follows is a pretty graphic account of some of the more vivid and disturbing things I have seen lately. What on Earth could I possibly be referring to? Some hideous uterine surgery? Yet another rant on the smells du jour emanating from vaginas? The time my older sister put me in a dress when I was three years old, only to find out that I had peed all over it in my first (and most successful) act of sibling defiance? No, no. What I want to tell you all about is much simpler than that, much more basic to the ties that bind us all in that vast tapestry of humanity. Yes, ladies and gentlemen, I would like to talk about that special thing known as...the miracle of life:

What was a slow call night changed with a simple tug, as the residents decided it was time to break the water of one woman in labor in order to help her proceed with the delivery. For those of you who don't know, this involves taking a plastic stick with a little sharp edge at one end, sticking it into the vagina, latching it onto the bag, and tugging to your hearts content until a nice wad of mucous and urine bursts onto your (hopefully) gloved hand. I hope you aren't grossed out yet, because this gets much worse (and by "worse" I mean more miraculous, of course!).

We left the room soon thereafter (because there is usually a few hours of delay between bag rupture and the actual delivery), returning to the call room and the comforting confines of Sex and The City reruns while we casually glanced at the fetal heart rate monitors. However, five minutes later, we heard some serious moaning from the delivery room we had just been in, and everyone raced to the room to discover that the delivery was now imminent. When I arrived in the room, the patient was moaning, her legs bent and spread, revealing a pulsating vagina that was bright red. She started groaning in agony as the next contraction began while the residents encouraged her to push as hard as she could. Her face turned bright red, while beads of sweat trickled quickly down her face. Meanwhile, her husband stood there, hopeless and helpless, watching the proceedings with eager anticipation and a drop of guilt for being the reason why she was in all this pain in the first place*.

And then, something started happening. A baby's head emerging from the orifice that marked the origin of its creation one lusty, bourbon-filled evening approximately nine months prior? No. Actually, it became apparent that the fetus's heart rate was dropping dramatically. Using a complicated formula that weighed various metrics, data points, and fetal heart scores to determine a subsequent course of action (simply summarized as "Holy crap! Crap crap crap!"), the residents decided an immediate intervention was necessary to save the baby and the mother. Interestingly, the intervention at hand can be found in homes across America. Yes, using the finest technology that the American health care system can buy, the senior resident took a suction cap, stuck it on the head of the decompensating fetus, told the nurse to "let her rip", and started bringing the baby out with each contraction using a modified vacuum. She was literally sucking the baby out of the womb, and my mouth was gaping wide open out of shock and a tinge of fear, because, lets face it, I once broke a vacuum accidentally sucking up a penny on the floor, so I can't imagine what kind of damage it could do to a baby's head.

After three attempts at tugging, with one trial that resulted in the vacuum popping off the baby's head because the resident was pulling so hard, the baby finally started emerging. A few more maneuvers later, and the baby was finally out, a NICU team waiting to receive her and make sure her decompensating heart or sucked out head were not reason for long-term concern (they weren't). However, on the way out, the baby did leave a little goodbye note to the mom in the form of ripping the mom's vaginal wall all the way down to her rectum. Ya, you read that right. Making the phrase "Hey baby, can I put it in that other hole tonight?" all the more complicated, this poor woman now had a direct communication between her vagina and her rectum, a complication of pregnancy that will almost universally lead to bowel incontinence (in other words, poo all over the place, all the time) for the remainder of this woman's life despite the best post-partum surgical correction.

Then it got even more fun: the placenta still had to be removed. Except as a result of a prior C-section, it had adhered to the muscular layer of the uterus (called placenta accreta - Does all this fancy doctor talk turn you on? I'm really that desperate. But I digress.), so all the tugging of the cord wasn't helping in the slightest. The resident knew what she had to do, something so shocking, so vile...ah screw it: basically, she stuck her hand up the woman's vagina, reaching in further and further (and further!), until her arm, all the way up to her elbow, was inside this woman's nether regions and fishing around to pull out the fixed placenta. She then repeated this same arm exploration two more times. My mouth, previously wide open, had now fallen all the way to the floor, as I had never seen anything quite like that (although I guess this can't be too shocking to you porn fiends out there). I must admit, reader feedback notwithstanding, an "I shit you not" is in order here.

Luckily, the placenta was removed, the baby delivered, and the mom still in one piece, quickly calmed by the cries of her new baby and the chance to hold the baby in her hands for the first time.

What did I learn here? Well, basically, it can be summed in two succinct thoughts:

1) Thank God I don't ever have to go through that. As suggested by the title of this post, I have a newfound respect for what women have to go through to deliver a baby vaginally, and I can't even begin to imagine how terribly painful this must be for them. Now of course, not all deliveries are riddled with complications like the one I just described, but still...well, I'll take the prostate, thank you very much. I realize this newfound appreciation I have for the pains of childbirth may be simply stating the obvious for many of you, but this is really something that is hard for any 20-something male to appreciate unless you actually witness a live birth fraught with complications (and my hunch is the vast majority of you have not seen a whole lot like this), hence my desire to share.

2) That whole miracle of life thing really doesn't begin to describe the mucous, urine, poo, smells, pain, vacuums, and so on that are actually inherent in the process of delivering a baby. So maybe instead of "miracle" we could refer to it as "The unfortunately designed method of life delivery, full of bodily secretions, that I guess is a miracle but is still really gross." Just thought I'd throw that out there.

*That sounded nice, eh? The husband all caring and stuff? Well, it turns out that's just me drifting into fantasyland and not actually a representation of reality. Do you really want to know where the husband's eyes have been focused in the three deliveries I have been involved with so far? The Apprentice, Monday Night Football, and that bastion of riveting television, Telemundo. Christ, guys, is it really that hard to focus for like 10 minutes while your wife/significant other/whatever is pushing a watermelon out of her vagina? It's just poor form. That said, it was a damn good episode of The Apprentice.

Monday, October 10, 2005

Cunning Linguist

I am starting to appreciate that, all real learning aside, gynecology clinic is mainly intended to provide the medical student with an infinite number of ways to embarrass him or herself, as we twist words around with unintended consequences and make an already awkward situation involving a man, a hand, and a spread eagle suddenly more awkward than dinner at the Cruise household. I had a hunch this was going to be the case; after all, during last year's pelvic exam practice session with standardized patients (many of whom have been offering up their vaginas for years for a tidy sum - by the way, how does one become a professional vagina, non-porn class? Do they just wake up one day and discover their true calling? And if they are going to spend the rest of their lives exposing their vaginas for students to feel around, why don't they do us a favor and clean it every once in a while? OK, I'll stop.), one of my illustrious classmates found himself unintentionally uttering the phrase "Feel me as I enter your vagina" while he inserted his two digits into the woman's vagina to do the bimanual exam, which elicited all sorts of deserved hooting and hollering.

Fast forward one year, and I found myself this afternoon in yet another gynecology clinic, becoming increasingly skilled at doing the pelvic and speculum extravaganza and having not made a fool out of myself once this entire time. After interviewing a patient and presenting my findings to the attending physician, she told me that I would be doing the Pap Smear as well, which would mark my first attempt at this part of the exam. (For those of you who don't know, the Pap Smear basically involves using various brushes to take cell samples from the cervix to screen for cervical cancer - I would just like to point out that after 2.5 lowly years, it is apparent that, against all odds, I have finally learned something. Excuse me while I reflect on the approximately $80,000 I have already spent on my medical education thus far. OK, I'm done.) Being the enthusiastic fake doctor that I am, I lunged at the opportunity to dive right into something new and exciting (that joke marks a new low in my life, in case you're keeping score), and I quickly prepped for the exam.

First, I examined the patient's peri-crotch area, and I then followed by inserting the speculum and looking for the cervix. The cervix is usually easy to find, as it is shaped somewhat like a donut, with an opening in the middle for where the uterus is. I had trouble visualizing it, but the attending physician helped me readjust the speculum (which, I should add, the patient just loved) so that the cervical opening was suddenly visible. I returned to the action and the doctor handed me the brush. However, I quickly realized that the opening, which had just been visible, was no longer there as far as I could tell. Panicking like the little puss that I am, I quickly turned to the attending and uttered these words:

"Umm...I just got lost in this woman's vagina and now I can't find the hole. I can't find the hole!"

I swear to you all that I actually said that, out loud. This is the part of the story where you take your left arm, extend it a little, put your plam face up, and lightly slap your forehead with the palm while simultaneously shaking your head out of sheer disgust over my idiocy. Thanks.

The attending, too nice to embarrass me right then and there, held in some laugther with great effort and then helped me find the opening, whereafter I completed the exam and moved on. Afterwards, in her office, my attending turned to me and said, "So...having some trouble finding the hole eh?", and I suddenly realized what I had said and turned bright red. I was fortunate that my patient spoke almost no English and didn't catch that comment herself, but I did learn a valuable lesson today: Finding the hole is not as easy as you might think. So ladies, cut us some freaking slack. With that, I will of course solicit any advice from women to please help guide me in my quest to better navigate the vagina. It's a matter of your health...and mine.

Friday, October 07, 2005

I'm Every Woman

The scene: Labor and Delivery Night Call. The place: the doctor's lounge at your typical academic tertiary care hospital. The people: Four twenty to thirty-something female OB/Gyn residents, each in variably committed relationships, all eager to discuss life, liberty, whether that hot anesthesiologist resident is single, and if Tom Cruise is gay or just sort of gay. Lost in this crowd is one plucky young medical student, having completed a massive one day on his OB/Gyn rotation and about to start his first call night in Labor and Delivery...

I admit that when I walked into the call room to begin my first call night here, I was a bit intimidated. Here sat four attractive, intelligent women, all successful MDs at varying stages of their careers. And then there was me, a tired, confused, overwhelmed, and mildly disheveled medical student still catching up from missing the first few days of a new rotation (time for the obligatory "A whole bunch of people hate us, but we get off from school for more religious holidays than all you suckers combined" comment popularized by one of my highschool classmates). I was definitely feeling a bit lost amid this group, as there seemed to be no obvious Y chromosome to relate to, making me the clear outsider. Would they reject me? Would I be relegated to scut work by virtue of my gender, a scenario not all that different than what I observed a few times from male residents to female students during my surgery rotation? Would any of these women go out with me?

Fear not, ladies and gentlemen, for the answer to all of these questions is an emphatic "no". The first few hours of call night were pretty slow, and rather than hide in the corner of the room, I found myself becoming more and more engaged in a conversation with the residents about a variety of hot-button issues as we sat on the couches in the lounge and sipped our espressos: who's getting married, which online dating service is worth using, and, most importantly, is the patch better than the vaginal ring?

Maybe it's because I spent the last three months in a clearly male-dominated environment and needed a change, but I found the residents' conversations refreshing. Before I knew it, I was totally getting into this conversation. Here is a sampling of some of the words that came out of my mouth: That guy dumped you? He's a fool! She slept with both of them? Dirty ho! That's the best excuse he could come up with? Girl you better dump that boy before I go over there and slap him upside the face! Let's watch Access Hollywood. Isn't Noah Wylie just so dreamy? Why aren't there any doctors like him around here? Don't mess with that nurse, she's on her period! What's the next book for Oprah's book club?

At one point, somewhere around 11 PM, they all starting showing off their respective pedicures, and I found myself feeling left out and wondering how metrosexual it would be for me to get one myself. Then they all started braiding each other's hair. I shit you not. Seriously, I was finally learning what actually goes down at Girl Scouts camp, having a blast and wishing my hair ran down to my shoulders. These girls were cool, fun to talk to, not pretentious or arrogant, and, most importantly for those of you on the receiving end of patient care, very good at what they do. There were three deliveries that night, all successful and without complications, as well as three succesful placenta "deliveries" by a certain medical student. (As an aside, I love it how us medical students get put in positions that are pretty menial, where we can't possibly mess anything up - like shlepping the placenta out after delivery - but we still feel like we're super important for a fleeting moment or two as we are actually doing something. Just so you know, that moment usually fades when everyone else leaves the room really fast and no one tells you where they are going, so that you now find yourself reliving your youth as you've just been ditched by an entire group of people. Not that that has ever happened to me before or anything.) In all, it was a great night. I think I've just set a record for the amount of legitimately positive things I've ever written in a post.

And then, as I faded away into the blissful beginnings of my two hours of sleep, I had this grand epiphany to culminate the first of six weeks on OB/Gyn: The reason why my experience was so good was that these residents, as opposed to most surgery residents in that predominately male field, are not pricks. And the reason why they are not pricks is because...well...they don't have any. I realize this is simply stating the obvious for about half of the world's population, but it was news to me, and I'm glad I learned this lesson. Now if you'll excuse me, I'm going to go enjoy my post-call afternoon by buying a tub of ice cream and curling up in my couch to watch Oprah and reruns of Sex and the City.

Wednesday, October 05, 2005

For Sale: My Soul

Last week, during another one of our Doctoring classes (that class that every medical school has where they try to teach us how to be sensitive, caring doctors informed on relevant medico-psychosocial issues - by the way, can you actually teach a grown adult to be sensitive? If you haven't developed any sensitivity by the time you're in your 20's, are you going to ever? I think you see where I'm going with this.), we had a three hour discussion devoted to Big Pharmacy, that evil seductress in all her tight black leather naughtiness, and how we as (fake) doctors are being manipulated by pharmaceutical companies for their own bottom line at the expense of our patients. Were we responsible for the deaths of patients who received drugs that were not up to par but we still prescribed based on false information given by the drug companies (i.e. Vioxx)? Are we allowed to advocate one drug over another for reasons other than those based purely on drug efficacy? Should we receive gifts from pharmaceuticals, from the smallest pen to the largest free trip to Hawaii? Is it undeniable that the erectile dysfunction drug reps are some of the most ridiculously hot women on the planet?

As you might imagine, not one of these questions was answered (and that last one wasn't even addressed...but it's so true.). In fact, our group spent so much time just trying to define a set of rules that allowed us to receive some gifts and allow some drug rep influence but reject others, that we never really got to any heart-of-the-matter concerns. I walked away from that meeting dissatisfied, yearning for some guidance on how to proceed with the big drug companies hovering over my shoulder like a dark shadow leading me into night. Was that dramatic enough? Anyways, I thought I would explore this topic here, because I think it would be useful for you all to see how easy it is to judge doctors with respect to this topic, but how hard it is to actually deal with the challenge at hand if you're in this position.

Like I mentioned above, finding some sort of middle ground in dealing with drug companies and their attempts to brainwash us into using their products was a pretty futile affair. Our group got so bogged down in different scenarios, with each of us harboring our own opinions, that it was evident no clear-cut rule was to come of this. Given that, it is clear to me that doctors really only have two options, and I'd like to take each option seriously (or as seriously as I can):

(1) Reject any and all efforts by the drug companies to buy us out - By adhering to this philosophy, you must reject any gestures by drug companies to influence your decision-making. This means no free lunches, no free pens, no informative brochures, no funding for drug research to be carried out at academic institutions and, most importantly, no harmless flirting with the female drug reps. Now, any non-medical professionals out there might think this is a reasonable goal to strive for, because after all, we are there for the patients and not anyone else (and, after all, this notion of not accepting gifts works so well in other facets of modern life, like our government). However, even though I've only been in the chaos that is your average hospital for a few months now, I realize how daunting of a task this is to actually achieve. Lets take the "no pens" rule as an example. No pens. Seriously, this seems so easy a retard could do it (wait, what was that thing about sensitivity I was talking about? Oh, whatever.) Seems easy, but picture this scenario (which actually happened): You're the attending physician in a ritzy urology practice. You just finished interviewing a patient, but realized you have no nice pen to document the encounter. Just then, a ridiculously hot woman arrives, rolling a small suitcase full of Levitra goodness behind her. She gives you a kiss on the cheek and offers to skip her pitch because she knows you are really busy. You then realize you are completely out of pens, and kindly ask if you can have one of hers. She offers you the Levitra pen, so futuristically designed that when you press a button, the pen literally mimics a penis going from the flaccid to erect state while revealing the ink dispenser (yes, they actually have these pens). You take the pen, write your note, and mindlessly shove the pen in your pocket, only to find yourself prescribing Levitra over other equal drugs at a later date without even thinking about it. Congratulations, you have just been claimed as sucker #23478925782398547, and you didn't even notice. What point am I trying to make here? You're about as likely to make it through an entire career in ANY medical profession (doctors, nurses, techs, etc.) and be able to withstand even the slightest drug company pressure as I am of convincing a few of my newfound readers that I'm not actually a pervert and that I don't go around giggling, pointing, and screaming "FISH TACO!" every time I see a vagina in an ob/gyn clinic. So this extreme is, quite simply, not a viable option.

(2) Throw yourself at the mercy of the drug companies, latching onto every free piece of crap that you can find - Now we're talking! By adhering to this philosophy, you accept the fact that drug companies are pervasive in their marketing and will not just go away, so the only way you can combat that is by accepting EVERYONE'S crap and ensuring that you can't be biased towards any particular drug because you took free stuff from everyone. Hold onto every Levitra penis pen around. Take every free trip they'll give you. Soak up all the commercials you can*. Hell, you could be even more subversive: take everything you can, and then prescribe no drugs at all ever! (OK maybe that's going a little too far, but as one reader pointed out to me, it's very true that US doctors seem to rely too heavily on pills and less on non-pharmaceutical methods of healing.) Sounds good, right? Wrong. Lets take this a little farther, because you all know this is going to happen eventually as we teeter down this extreme path. Soon the companies catch on that you're just taking their stuff and not actually giving their drugs to your patients over he other company's drugs. So what do they do? Make you look even more ridiculous. I'm talking automated drug reps in patient waiting rooms. Drug logos emblazened all over your white coat, NASCAR-style. And just imagine the day you sink low enough to where you have to start saying stuff like this:

"Please lower your pants and I'll perform the rectal examination. I would like to remind you that this rectal exam is sponsored by the good folks at ExtremeRestraints.com, makers of quality anoscopes used by hospitals and anal fetish proponents worldwide. If you would like to purchase a home anoscope device, please talk to our receptionist outside. I will now insert my finger into your rectum."

Yikes.

Anyways, I hope you are starting to appreciate the bind we're in as medical professionals. I realize that, as patients, you probably still don't care so long as you get the best medical treatment you can without the sense that your doctor has been bought out by some random drug company. But please at least think about these issues, and if you have any bright ideas on how to pursue an even path, let me know. And if you're a drug rep for those erectile dysfunction drugs, I'd just love to hear from you (and hear about your drugs blah blah blah).

*Except for that goddamn Celebrex commercial. I swear every time I hear that jingle I want to break something. Crap, just thinking about it has that song in my head. Nice move.

Saturday, October 01, 2005

Ask The Fake Doctor 2

Proving once again that I will respond to your questions, I have decided to institute another installment of Ask The Fake Doctor. I should remind you that these questions are not made up and have not been altered from their original text (save a spelling correction here or there). I should also remind you that not one of these people sent me naked pictures of themselves, despite my constant pleas. So thanks a lot, everyone.

You are my new hero. I stumbled upon your blog a few days ago and after reading Eagle Eyes I realized I was home. I think it was your poo-talk that reeled me in...just on your porn/anaesthetics analogy: isn't the anesthesiologist really like the back-up super-stud for when the lead male totally screws up and needs the actually-not-so-auxillary male to come save the day? Just a thought after I sawt he anesthesiologist save the life of a woman who really wanted to die in the gyn OR. I mean this guy's performance was so good that even the surgeon couldn't stop raving about him. Think about it, lead male can't stop raving how amazing Rock Highlands saved the day.-R. R., Sydney, Australia (How's that for international appeal?)

Ignoring the fact that I left in the part about being someone’s new hero only to make myself feel better when it is so obvious that that statement has nothing to do with the question, you bring up an interesting point. Could I have been mistaken about this analogy, overlooking the instances when anesthesiologist does step up to not only bang the porn star, but also make the male lead look flaccid and small in the process? Perhaps, but first of all, the situation you describe is exceedingly rare. In all of the OR time I have experienced in the last three months, I have never seen anything even close to that which you describe. Which is not to say it doesn’t happen, because I’ve heard stories like yours before. Surely there is some porn movie where the above scenario ensues. However, what I have heard and seen far more frequently is the anesthesiologist screwing up (or cockblocking the male lead, if you want to keep this porn analogy going) and requiring gentle reminders from the surgeons to do their jobs appropriately (these go usually something like “STOP READING YOUR GODDAMN MAGAZINE AND FIX THIS NOW!”). In porn terms, the dialogue might go something like this:

Female lead/Patient: It’s so hot outside…I’m all soaked and wet.Male lead/Surgeon: I’ll cool you off, baby, with my shower of-Back-up/Anesthesiologist: [Busts open the door, barges in] Hey guys! What’s going on over here? Anyone want to play Scattergories?Male lead/Surgeon: Put that away before I shove that board game up her ass!

‘Nuff said.

Being a Jewish male of 54 I have a question for you. How is it that a Jewish male med student at a prestigious school, with a great sense of humor, every Jewish mother's dream, has trouble getting girls? They should be standing in line.-M. A., Barrington, Rhode Island

I really have nothing to add here, I just wanted everyone to see this.

Do you find every time you do something dumb now people say "oh God, and YOU'RE going to be a doctor?" That pisses me off. Can you write something about that? Like if I pull on a door that says push or can't figure out how to get the dvd player to play, that increases the likelihood that I'm one day going to kill someone in surgery by 30%?-S. W., Hamilton, Canada

Having (1) referred to myself as my sister’s sister (think about it) on multiple occasions (including one time on her bat-mitzvah video, a moment in time to be cherished for eternity), (2) almost knocked myself unconscious while banging my head against one of the lights in the OR two weeks ago, and (3) been told by a standardized patient who was evaluating my clinical skills that I made an orgasm face when I was listening to her heart and lungs (I have a written evaluation to prove that), I know a thing or two about making an ass out of myself. And yes, I get the same nonsense from non-medical people about how I am obviously too incompetent to be in charge of saving other peoples' lives when I cannot even figure out how to open up the button placed ever so confusingly over the fly of the boxers I bought at Costco a while back. (But seriously, why the hell is there a button over the fly? I don’t get it.) However, rest assured that there are a few ways to respond to this:

1) “You think I’m stupid because I can’t do [insert menial task here]? Excuse me, but I’ve been too busy exploring the most advanced surgical techniques and the latest breakthroughs in drug development to waste my time pondering the intricacies of your simpleton DVD player. That is a task better left to people like you, don’t you think? That’s what I thought.”

2) “Does that door really say ‘push’? Why don’t you hold onto this big stack of degrees I received from prestigious universities while I go in to take a closer look.”

3) “You’re right. I’m a total klutz. I’ll never be any good at this. I am more likely to kill someone because of my faults. But you know what? This school’s pass/fail, baby. And guess what? Everyone passes. Which means I’m getting that MD whether you like it or not. Keep that in your mind the next time you show up to the ER clutching your chest in agony and seeing my beautiful face staring back at you. Prick.”

Fake Doctor, is there anything us bigger chested women can do like exercises or anything to prevent that sagging effect? Or perhaps we should get a breast reduction or someting...when we turn 70ish...is that healthy?-Anonymous, Anonymous-land

Not that I have any medical data to back this up, but I could have sworn reading somewhere that it definitely helps to work out those pectoralis muscles if trying to prevent saggy boobs. Intuitively, this makes sense because those are the muscles directly behind the breasteses (is that not the appropriate medical terminology?) and would be most likely to help support the otherwise gravity-challenged sack of fat that is breast tissue. That said, I invite any and all women with these concerns to send me pictures of their breasts, and I will be glad to provide an individualized workout and preservation plan geared towards maintaining the natural curvature of your breasts. (As an aside, this gratuitous solicitation marks a new low in my life, just in case you were keeping track of such things.) Finally, if you’ve made it to 70 and your back has withheld your breasteses without crippling pain, there’s really no reason to have a breast reduction, because it likely isn't going to make much of a difference anyways. And, lets face it, by the time you are 70, are you really going to care what some schmuck medical student thinks about your breasts? Probably not.

I Can Be Serious, Too

Ask The Fake Doctor:

Tales From The Crypt (And By Crypt I Mean Medical School):

Do you have aspirations of going to medical school and need some sense knocked into you? Do you work for a large publishing company and want to give me oodles of money to publish my stories of misery? Are you an attractive, single, Jewish female? Email me at: thefakedoctor@gmail.com